Details

A SWMS is a risk assessment tool that provides you with the work methodology required to complete a job safely.
Division Business Unit Date SWMS No:

Work Activity

Permit Work
This activity to
Plant and Equipment involves the following High Risk Activities. If any of the below activities are involved,
be Used check with the Plant
Competencies Work Controller to see if an ATW is needed, ensure that an On the Job
and Qualifications
Assessment & Discussion is held and this SWMS is amended if required and made specific to the job with input from the work crew.

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Work Method
The work method explains the steps to carry out the process, hazards associated with the work and what controls are to be in place to complete it safely.

Step What is the What are Initial Risk What? Residual Who is
No. Task Involved? the Hazards? Risk Responsible?

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 C L R C L R

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SWMS No: Job Title: Page PAGE \* ME
 On the Job Assessment
What might be missing from the work method? Are there additional Hazards and Controls that might have been missed?

Pre-Start Checks Date

The work group is not rushing, frustrated, fatigued or complacent

The work group are fit to do the task

The work group clearly understand the task

The work group are authorised and competent to do the task

All members are wearing the appropriate PPE

All Pre-Start Checks have been completed

Other work crews have been notified if they are affected

What are the Additional Hazards? What are the Additional Controls? Who is Responsible?

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SWMS No: Job Title: Page PAGE \* ME
 I confirm that the persons listed below have reviewed and been given instruction in this Safe Work Method Statement (SWMS) and were given the
opportunity to ask questions and clarify any areas of uncertainty. To the best of my knowledge these persons gained a full understanding of the work method
and required health and safety controls to be applied for this job.

Person supervising the work:

Signature: Date:
(e.g. Manager, Supervisor, Team Leader, Leading Hand, etc)

Work Activity Instruction Record

By signing this I acknowledge that I have been instructed and was given the opportunity to provide input into the work methodology and on the job assessment.
Name: (Please Position/Company: Employee/ Signature: Date:
Print) Contractor:

SWMS No: Job Title: Page PAGE \* ME

 Prepared By / Review Team
Name: (Please print) Position: (Please print) Signature: Date:

Authorisation
I have checked this Safe Work Method Statement (SWMS) and confirm that it is authorised for use.
Person supervising the work:
Signature: Date:
(e.g. Manager, Supervisor, Team Leader, Leading Hand, etc)

Name: (Please Print) Position/Company: Employee/Contractor: Signature: Date:

SWMS No: Job Title: Page PAGE \* ME

 TABLE 1: Qualitative Measurement of the Maximum Credible Outcome of an Event

Value Description Impact

Health: Illness or effect with limited or no impact on ability to function and treatment is not necessary.
Safety: Injury such as First Aid, usually dealt with in-house.
1 Incidental Environment: No discernible impact or measurable impairment on habitat, species or natural environment (air, water, land).
Regulatory: No risk of punitive actions and any intervention limited to an observation.
Community/Reputation: Isolated complaint from a local individual.
Health: Mild illness or health effect which requires some treatment and/or has some functional impairment
but is usually easily medically manageable.
Safety: One or more injuries which require treatment by a medical professional or as a hospital outpatient, but are not serious (e.g. no time lost).
2 Minor
Environment: Localised and measurable short term impact on habitat, species or natural environment.
Regulatory: Risk of punitive action unlikely and any intervention limited to field report (or similar).
Community/Reputation: Clustering of complaints and risk of local media interest.
Health: Illness or significant adverse health effect needing a high level of medical treatment or management.
Safety: One or more injuries which are serious enough to result in lost time, non-permanent disabling injuries,
or overnight hospitalisation as an inpatient.
3 Moderate Environment: Localised and measurable medium term impact on habitat, species or natural environment.
Regulatory: Formal intervention, typically issuing of an Improvement Notice at a site and unlikely to escalate
if complied with. Fine up to AUD 100K (or equivalent) without criminal proceedings.
Community/Reputation: Coordinated community concern at a local level, and limited local media coverage.
Health: Illness or chronic exposure resulting in significant life impacting effects
Safety: Minor permanent disabling injury e.g. loss of finger(s) or extended temporary impairment and/or hospitalisation.
Environment: Extensive and measurable medium term impact on habitat, species, or natural environment.
4 Major
Regulatory: Formal, high level intervention (e.g. prohibition notice) at a site, and risk of further interventions at other sites.
Significant fine or penalty likely for Corporate (greater than AUD 100K or equivalent).
Community/Reputation: Community alarm at a regional level, and adverse and longer running local/regional media coverage.
Health: Serious illness or chronic exposure resulting in fatality or significant life shortening effects.
Safety: Death or significant permanently disabling injury e.g. blindness, loss of hand(s), quadriplegia.
5 Severe Environment: Destruction of important populations of habitat, species, or natural environment.
Regulatory: Significant prosecution action, including risk to Company Officers.
Community/Reputation: Widespread community unrest and/or adverse national/international media coverage.

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 TABLE 2: Qualitative Measurement of How Likely or Probable the Consequence will Occur

Value Description Impact

5 Almost Certain The event is expected to occur several times a year at a site/local level.

4 Likely The event is expected at a site/local level in the foreseeable future (next few years) / Occurs within the Company more than once per year.

The consequence is possible at a Company workplace at some time in the foreseeable future (next 10 years) / Has happened at the Company
3 Possible
in past 10 years / Occurs annually within the Industry.

2 Unlikely The consequence is possible in the Company / Has occurred in the Industry.

1 Rare The consequence is not expected in the Company / Has never been heard of in the Industry.

TABLE 3: Qualitative Risk Matrix – Levels of Risk

Consequence Incidental Minor Moderate Major Severe

Likelihood (1) (2) (3) (4) (5)

M H E E E
Almost Certain (5)

M M H E E
Likely (4)

L M H H E
Possible (3)

L L M H H
Unlikely (2)

L L L M M
Rare (1)

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